Exam 3 Flashcards
what are the 4 main body fluids HIV is commonly spread?
- blood
- semen
- breast milk
- vaginal secretions
HIV is most often transmitted through what? (3)
- sexual contact
- parenteral
- perinatal
what type of sexual contact is highest risk for HIV transmission?
anal sex
re: parenteral HIV transmission, what years were the higher risk years for transmission via blood products?
1978-1985 (before screening of blood products)
what are interventions for parenteral HIV transmission?
HARM REDUCTION
cleaning needles, needle exchange, PreP
how long should babies be treated with HIV drugs after delivery (from positive pregnant person)?
4-6 weeks post delivery
increased viral load means what?
increased chance of transmission
what is best thing health care workers can do to prevent HIV transmission?
standard precautions + use of safety needles
+ post exposure prophylaxis within 24 hours if exposed ◡̈
what does the 4th generation HIV testing detect? + in how many days?
HIV antibodies: 21 days
HIV p24 antigen: 14 days
if 4th gen HIV testing is positive, what is protocol? if negative, what is protocol?
positive –> test for HIV strain
negative –> test with another test (NAAT)
re: home testing kits for HIV, what should be done?
results verified w/further testing
what is viral load measuring? + what can it track?
amt of HIV viral RNA in blood
tracks: infectivity + therapy effectiveness
ideally, how often should a patient with positive HIV diagnosis be monitoring their viral load?
per Messer, q 2-3 months after diagnosis
what would we see re: these labs with AIDS?
lymphocytes:
CD4:
viral load:
lymphocytes: LOW w/fully progressed AIDS
CD4: decreases over time
viral load: increases over time (ART meds can mitigate this)
re: HIV/AIDS, CBC + CMP can help to track development of what?
opportunistic infections
what are the 3 stages of HIV/AIDS?
- acute (flu-like; VERY contagious)
- chronic (asymptomatic; can transmit to others)
- AIDS
what is timeframe to see acute HIV stage after transmission?
2-4 weeks after transmission
what are the 2 AIDS-defining parameters?
- CD4 <200
or - development of opportunistic infections
what is normal CD4? what are the CD4 counts associated with each HIV stage?
normal 500-1500
- acute: >500
- chronic: 200-499
- AIDS: <200
- unknown: not enough info about CD4 or opportunistic infections
who should be screened for HIV?
13-65 yrs old (at least one test)
higher risk/repeated high risk exposures (IVDU or sex workers) –> annually/frequently
what is the PRIORITY assessment of positive HIV/AIDS patient?
KNOW
early detection + management of infections
patient education
what is PRIORITY nursing care for patient with HIV/AIDS?
handwashing!! (infection risk - keeping patient safe)
what is most common opportunistic infection with AIDS?
KNOW
Pneumocystis pneumonia (PCP)
how does pneumocystis pneumonia present? (name s+s)
KNOW
PNA:
cough, dyspnea, SHOB, crackles in lungs, fever, tachypnea
what is tx for pneumocystis pneumonia?
KNOW
antibiotics (bactrim) + support (O2 + positive pressure)
these txs can increase risk of infection even more :(
disseminated MAC has ONLY been seen with which 2 scenarios with AIDS patients?
KNOW
- CD4 <50
or - patients not on ART drugs
if patient receives PPD test and is HIV positive, what is positive result?
> 5mm
may not be best screening test for immunocompromised - best with NAAT, CXR or sputum
what do we need to KNOW about Kaposi’s sarcoma r/t AIDS?
that it improves with ART drugs
per Messer
what interventions r/t oxygenation should we implement for HIV/AIDS patients?
elevate HOB + O2 therapy
what interventions r/t nutrition should we implement for HIV/AIDS patients?
high calorie, high protein, low fat
small, frequent meals
how can we educate patients with HIV/AIDS to prevent infection? (7)
- monitor vitals + temp
- no fresh plants, flowers or sick visitors
- avoid raw foods
- handwashing
- don’t handle pet litter
- bathe daily
- don’t share personal items
what are the characteristics of all autoimmune disease?
- periods of exacerbation + remission
- chronic + progressive
- systemic effects: fever, fatigue, weakness, anorexia, weight loss
- inflammation of connective tissues
what is the pathophysiology of RA?
forms autoantibodies + rheumatoid factors that affect healthy tissues (especially likes synovial joints)
what can happen with RA over time if left untreated?
major deformities + bone fusions
when does RA often present?
winter months
what are the s+s of RA in early stage?
red, warm, tender, swollen + stiff joints - symmetrical
what joints are most commonly affected with RA?
upper extremity joints (synovial)
what are the s+s of RA in late stage? (5)
- inflammation in more joints
- gel phenomenon
- joint effusions
- spindle like fingers
- muscle atrophy –> dec ROM
TMJ with RA signifies what?
SEVERE disease
RA affecting cervical joints puts a person at risk for what?
paralysis
aside from the “usual” systemic effects of RA, what other things can you see? (3)
- subcutaneous nodules (forearms)
- vasculitis
- paresthesia –> foot drop
“Very Painful Shit”
re: RA, what is vasculitis? what does it present as? what is person at risk for?
what: inflammation of vessels
presentation: periungual lesions on fingers
@ risk for: organ ischemia (kidneys + lungs most worrisome)
what are Baker’s cysts and which condition are they associated with?
enlarged popliteal bursae; associated with RA
tx of underlying disease is best for these
what is sjorgen’s syndrome?
attacking glands that lubricate; often with another autoimmune disease
eyes, mouth, vagina
re: RA, what should we be examining with these patients in regard to quality of life?
how are their ADLs impacted? are their medications working and helping them to achieve their ADLs? <3
diagnosis for RA
no definitive; only supportive; very difficult
if an arthrocentesis was performed on a person with suspected RA, what findings would you expect to see?
fluid cloudy w/WBCs
what is our priority intervention for person wtih RA?
rest, balance + setting priorities
if patient with RA was too tired to take a bath and wanted to skip it, what would be your best response?
teaching them why hygiene is so important, especially with immunosuppressive medications + offering a bed bath with CHG wipes
describe the differences between RA + Osteoarthritis
RA: autoimmune, symmetrical, worse after resting
OA: wear and tear/degenerative, generalized, worse after activity
pathophysiology of SLE
production of antinuclear antibodies + immune complexes
re: SLE, the immune complexes have an affinity for which organ?
kidneys
can impact the organs directly or the vessels that perfuse them
SLE is most common in which population
females of color
what is the unique sign of SLE?
“butterfly rash”
function of which organ is VERY IMPORTANT with SLE?
kidneys - because the immune complexes are nephrophilic + cause systemic inflammation
this condition is triggered by stress or cold and NOT exclusive to Lupus
Reynaud’s Phenomenon
extreme pallor or red/blue of fingers –> can lead to loss of digits
what is our priority nursing education for patient with SLE?
avoid direct sunlight + wear sunscreen (skin protection)
+ derm referral is also important
what symptom do we educate patients with SLE to monitor for to recognize impending exacerbations?
low grade fever
what is systemic sclerosis?
autoimmune disorder causing hardening of skin + eventually inflammation of connective tissue
what is leading cause of death with systemic sclerosis?
kidney sclerosis (systemic inflammation)
limited cutaneous systemic sclerosis is associated with which syndrome? describe it.
CREST
Calcium deposits in skin Raynaud's phenomenon Esophageal Dysfunction Sclerodactyly (tightened skin on fingers/toes) Telangiectasis (spider capillaries)
s+s of systemic sclerosis (6)
- painful + stiff joints
- pitting edema
- shiny skin (b/c of hardening)
- taut skin
- joint contractures
- loss of ROM
re: systemic sclerosis, describe the organ involvement (GI, lungs, CV, kidney)
digestive tract –> dysphagia
CV –> raynaud’s
lungs –> pulmonary HTN
kidneys –> DEATH
what is #1 cause of death with systemic sclerosis?
kidney failure
based on googling, this is not accurate, but according to messer, kidneys are the cause
re: systemic sclerosis and involvement of digestive tract, what would be your priority intervention?
ability to swallow safely (r/t dysphagia)
what are 3 interventions for patient with scleroderma?
- bed cradle (avoid skin breakdown + pain)
- foot board (prevent contractures)
- keep room warm (prevent raynaud’s)
what is gout?
systemic arthritis r/t uric acid build up
NOT autoimmune
what is a very common cause for secondary gout?
kidney disease (hyperuricemia b/c of impaired excretion)
with acute gout attack, where is the pain often manifested?
big toe (excruciating!!)
what happens with chronic/tophaceous gout?
urate crystals deposit in major organs
re: gout, urate crystals have an affinity to which organs?
kidneys (nephrophilic)
s+s of gout
joint inflammation + severe pain
interventions for gout (2) + what things should be avoided?
- fluids
- low purine diet
- avoid ASA, diuretics, stress
what foods should people avoid with gout? give examples
KNOW
purine-containing foods
avoid organ meat, shellfish, oily fish w/bones
(egg would be good protein choice)
main interventions for patients with sensory problems
know how to optimize communication + keep patient safe (per Messer) **
what is our priority assessment and intervention for patients with sensory deficits?
communication + anxiety (per Messer) + keeping them safe
what is cataracts?
lens opacity + cloudiness
what are the 2 major risk factors for cataracts?
KNOW
aging (>70) + sun exposure (not wearing sunglasses)
what would you see re: vision with person with cataracts?
blurred vision + decreased color perception
–> leads to double vision
what is priority intervention for cataracts?
sunglasses + hats (sun protection)
after cataract surgery, when will you see vision improvement?
improves 1st day after surgery –> max 4-6 weeks after
after cataract surgery, what should be reported? (3)
- s+s of increased ICP (ex: pain, N/V)
- infection
- bleeding
what restrictions should be in place for patients following cataract surgery?
activity restrictions - avoid anything that could increase ICP
what is the patho of glaucoma?
increased pressure in eye –> pressure on nerves –> nerve death –> blindness
can glaucoma be prevented?
NO, but we can treat it to prevent blindness
glaucoma is associated with a gradual loss of what (r/t vision)?
peripheral vision
what is best way to detect glaucoma?
+ what is normal tonometry measure?
YEARLY eye exams (tonometry: “the lil puff of air; normal 10-21 mmHg)
what is most common type of glaucoma?
KNOW
Primary open angle glaucoma
s+s of primary open angle glaucoma (3)
KNOW
- foggy vision
- halos
- SLOW loss of peripheral vision w/no improvement with glasses
“angels (angles) try to see in the fog by putting on their glasses but don’t have peripheral vision”
what is primary angle closure glaucoma? what are s+s? (4)
ACUTE/ sudden onset EMERGENCY!!!
- severe eye pain –> radiates through face
- red sclera
- foggy cornea
- dilated + non-reactive pupil
how is glaucoma managed? + what is nursing role?
KNOW
with eyedrops
nursing role: proper eye drop admin education - wash hands, conjunctival sac, punctal occlusion to avoid systemic admin
what is macular degeneration?
deterioration of central vision
what is most common form of macular degeneration? what is patho
dry
retina capillaries are blocked –> ischemia –> necrosis –> complete vision loss
what are risk factors for macular degeneration?
- smoking
- HTN
- diet low in carotene + vit E
interventions are aimed at all of these
what are some nursing interventions for macular degeneration?
KEEP THEM SAFE
call bell close, items within reach, keep environment clutter-free, promote safe independence
what is retinal detachment?
separation of retina from epithelium
what are s+s of retinal detachment? (3) + what is onset? + what is pain level?
SUDDEN, painless
- flashes of light
- “floaters”
- sudden loss of portion of vision
what are post op nursing interventions for retinal detachment surgery?
- avoid fine eye movements (reading)
- monitor for infection
- wear eye patch
- educate patients about risk of repeated detachment
what is a great intervention for prevention of hearing loss r/t noise pollution?
wearing earphones to protect ears / hearing
hearing loss interventions are aimed at what? (3)
- the cause
- stopping progression
- restoring hearing
what should we educate patients on re: hearing aids and first time using them?
KNOW
when first getting used to them, everything will be louder, even background noise –> ease into wearing them, go for short periods of time at first and build up, avoid large crowds with lots of noise at first
what is osteoarthritis?
wearing down of cartilage in the joints –> leads to bone on bone –> PAINFUL
(“wear and tear” disease/degenerative)
where is osteoarthritis most commonly found?
hips, knees, spine, hands
what are bone spurs + where are they commonly found?
hard bumps of extra bone from osteoblastic activity
commonly in HEELS
what are the 2 primary causes of osteoarthritis?
aging + genetics
what would we see regarding activity + rest with osteoarthritis?
worse after activity + better after rest
what are the 2 distinct signs you may see with osteoarthritis?
bouchard’s nodes (proximal fingers) + heberden’s nodes (distal fingers)
what is our primary intervention for osteoarthritis?
pain management: tylenol first + then NSAIDs if person can take them
aside from meds, what are some other interventions for osteoarthritis?
- lidoderm patches
- hot or cold therapy (focus on heat)
- balancing exercise + rest
- non high impact exercise: swimming, walking, cycling, aerobics
can osteoarthritis be cured?
no - teach patients to be aware of curative remedies! many out there!
what is a total joint arthroplasty? when is it indicated?
surgical creation of a joint; indicated when quality of life cannot be maintained anymore
what are 2 most common locations for total joint arthroplasty?
knees + hips
what are the 5 contraindications for total joint arthroplasty?
- infection
- advanced osteoporosis
- severe inflammation
- severe DM
- on dialysis
what is MAIN focus of preoperative care for joint arthroplasty patients?
EDUCATION! set patient up for success before surgery + for when they will return home (do they have everything they need??)
what is important re: dental work after joint replacements?
patients should inform provider before surgery - antibiotic therapy to prevent infection
what are the two options for hip joint arthroplasty? how is it determined?
press fitted or cemented
(cemented deteriorates more quickly, so usually chosen for older adults, whereas press fit are good for longer periods of time, so often used with younger persons)
describe difference between press fitted or cemented hip joint arthroplasty
KNOW
press fitted: cannot immediately bear weight; osteoblasts need to build around this before stable; lasts longer
cemented: can bear weight immediately; deteriorates quickly
s+s of dislocation post op for total hip joint arthroplasty; what should be done?
- severe pain
- shortening or rotation of leg
immediately call surgeon!
people are at a very high risk of what post knee or hip surgery?
DVT + PE
monitor for s+s of both
to monitor for neurovascular compromise post joint arthroplasty, what should we assess?
CMS: circulation, motion, sensation
is there a pulse? can they move it? can they feel it?
what are 3 precautions to take post hip joint arthroplasty?
- knees at 90* angle
- don’t cross legs
- use abduction pillow (great for a confused older adult to prevent dislocation)
what positioning should be maintained post knee replacement surgery?
neutral position (avoid hyperextension + rotation)
if there’s a posterior approach for a total hip replacement, do you need an abduction pillow?
yes!
Random fact that Messer said to KNOW at the end of the lecture?
with any type of approach for total hip replacement, what are you worried about?
rotation
random fact that Messer said to KNOW at the end of the lecture?
what is osteoporosis?
chronic bone loss –> decreased density + increased fracture
(osteoclast activity > osteoblast activity = thin, fragile bones)
:(
what areas of the body are at highest risk of fracture from osteoporosis?
spine, hip + wrist
what hormone is very important to maintain bone density?
estrogen
when this drops w/menopause, someone is at high risk of developing osteoporosis
what are some risk factors for osteoporosis?
- female
- thin body build
- diet low in Vit D + calcium
- smoking
- estrogen deficiency
- excessive ETOH
- immobility
- medications STEROIDS - KNOW
what exercise should we be instructing people to do to mitigate osteoporosis development?
weight bearing exercise (pretty much anything but swimming)
what is the screening + diagnostic tool most often used for osteoporosis? what population should get this?
DXA scan; females >65 yrs old
re: DXA scan, what T score would indicate osteoporosis?
-2.5 or lower
re: DXA scan, what T score would indicate osteopenia?
-2.5 to -1.0
how often is bone mineral density testing recommended?
q 2 yrs for people > or = 65 yrs or w/risk factors!
in what other scenarios would bone mineral density testing be recommended?
- low estrogen
- long term steroid tx
- hyperparathyroidism
what is the main potential problem associated with osteoporosis?
KNOW
FRACTURES
name some interventions for osteoporosis
- weight bearing exercise
- vit D + calcium supps
- strengthening exercise
- drug therapy
re: osteoporosis + drug therapy, which T score would indicate a need for drug therapy?
T score < -2.0 with no risk factors
or
< -1.5 w/risk factors
what is osteomyelitis? & what does it lead to?
infection of body tissue (caused by bacteria, fungi or virus) –> inflammation –> bone necrosis
eventually becomes a chronic pathology
osteomyelitis results in what?
sequestrum (walled off area) + necrosis of bone
what is exogenous + endogenous osteomyelitis?
exo: infection originates outside body
endogenous: carried from another part of the body
what’s an example of an exogenous cause of osteomyelitis?
open fracture
which infection is highly related to osteomyelitis?
salmonella
what are the s+s of osteomyelitis?
- bone pain (constant, localized, pulsating) worst with movement
- fever > 101
- redness, swelling, tenderness, heat
what is intervention for osteomyelitis?
long term antimicrobial therapy via PICC line
what is a complete fracture?
bone broken into 2 pieces (often needs more invasive interventions)
what is incomplete fracture?
bone not broken into 2 pieces / still connected
what is open fracture? what is this type associated with?
bone sticking out of skin high risk of infection
what is closed fracture?
bone not sticking out of skin
greenstick fractures are often seen with which population?
kiddos (hard to break)
oblique fracture
runs up the bone
spiral fracture
runs around the bone (often from twisting)
re: age, what bones are most commonly affected by fractures?
young + middle aged: femoral (long bone area)
adults: ribs
older adults: femur (near “head” + can be any part)
what should be your priority assessment with fracture?
if it’s a trauma, think ABCs!!
otherwise - pain + CMS
if person presents to ED with pain and you suspect a fracture, what would priority be?
GET IMAGING
what s+s might you see with a fracture?
- pain (sometimes only symptom)
- change in alignment
- shortening of limb
- change in shape
- bruising
- swelling
what is priority assessment + finding with fractures?
CMS! (circulation, motion, sensation) anything different than usual
re: CMS assessment with a fracture, what is a sign of possible neurovascular compromise?
tingling + numbness (inflammation causing pressure on the surrounding nerves)
what can neurovascular compromise lead to?
compartment syndrome –> loss of limb or death !!
how do we diagnose fractures?
xray!
might also look at H+H with trauma b/c worried about bleeding
Patient presents to ED with multiple fractures complaining of excruciating pain. what would your priority nursing diagnosis be?
A. Pain
B. Potential for Infection
C. Potential for impaired circulation/ NV compromise
D. Immobility
C
neurovascular compromise can lead to compartment syndrome!
what is priority intervention for fractures?
if trauma, think ABC
if airway and breathing are OK, think circulation – fractures can cause swelling
how would we reduce risk of further injury with a fracture?
immobilize with a splint
what is your role as a nurse with closed reduction procedure for fracture?
support provider + patient by administering meds + monitoring patient
what is most common method to manage a simple fracture?
closed reduction (by advanced provider)
what type of immobilizer is preferred for fracture? why?
splints, b/c they can be adjusted
re: fractures, which body parts are splints most commonly used for?
body parts that don’t bear weight
re: fractures, which type of immobilizer can lead to compartment syndrome
casts
what type of fractures are casts usually reserved for?
complex fractures + LE fractures
what is the most commonly used material for casts? why?
fiberglass
dries quickly, reduces skin breakdown, can get wet
can fiberglass casts be fully immersed in water?
KNOW
NO
re: fractures, what is traction?
application of pulling force w/pulleys + weights
re: traction, what should you do if you see the weights on the floor?
CALL PROVIDER
what is balanced traction?
fractured extremity is suspended w/2 opposing forces
YOU CAN MOVE
what is running traction? can they move extremity?
fractured limb is opposing force; force is w/one plane only
CANNOT MOVE EXTREMITY - will change the traction being applied
what is one of the major differences between skin/skeletal traction vs running/balanced?
with skin + skeletal: bandage or anchored into skeletal system
running: one direction
ONLY balanced: person CAN MOVE extremity
what is skin traction?
force applied to fractured limb with bandage or splint
what is skeletal traction?
force is applied to fractured limb with pins inserted into the bone
what is Buck’s traction? what is it used for?
running (one direction) + skin traction (with bandages)
used for pain reduction often with HIP
what is one of the most common ways to reduce and fix a complex fracture?
open reduction w/internal fixation (ORIF)
with ORIF surgery, what devices are used?
metal pins, rods, prostheses
with ORIF surgery, what are you able to do immediately after?
MOBILITY! ◡̈
hi!
you’ve made it halfway through this semester. you GOT THIs ◡̈
hello future nurse
you will do great! keep up the hard work ◡̈
what is the most concerning complication from a fracture?
acute compartment syndrome
what is acute compartment syndrome?
when muscle swells within a compartment –> alteration in CMS (circulation, movement, sensation)
how can we detect and monitor for acute compartment syndrome?
frequent CMS assessments
what are the s+s of acute compartment syndrome?
6 P’s
pain, poikilotherma, paralysis, paresthesia, pallor, pulselessness
–> can lead to loss of limb!
what is fat embolism syndrome (FES)?
fat globules released with long bone fractures (also arthroplasty surgery)
what does FES present like?
broad, not specific symptoms
kinda like a PE
when does FES (Fat Embolism Syndrome) commonly occur after trauma?
24-72 hrs
what are s+s of FES?
hint: think of the 3 main body systems affected
think - lungs, brain, skin
lungs: low O2, dyspnea, tachypnea, SHOB
brain: confusion, HA, seizure, altered LOC
skin: petechiae
with FES, what interventions can we do for people?
prevention: early fixation
- support*
- raise HOB + O2 therapy
- fluids
- albumin (binds to fatty acids)
what 2 things define a surgical site infection? (time line)
if surgical site becomes infected within 30 days of surgery
OR
hardware becomes infected in the 1st year
what is most common injury in older adults?
hip fracture
hip fractures are associated with what outcome?
high mortality rate; r/t immobility –> myriad of problems
what is biggest risk factor for hip fracture?
osteoporosis
what medication should we avoid with managing hip fractures? why?
demerol (this can worsen delirium + outcomes)
what is your priority assessment and intervention with a chest fracture?
think ABC - breathing problem!
